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Robert G. Robinson, Dr.P.H.Associate Director for Health Equity
Office on Smoking and Health
TM
Community Development Model for Eliminating Disparities
Basic Assumptions
Core Determinates of Community,Race and Ethnicity
– History
– Culture
– Context
– Geography
History
African Americans– Slavery
Asian/Pacific Islanders– Weapons testing in Pacific Rim (Micronesians)
Hawaiian – Annexation, banning traditional practices
Hispanics/Latinos– Appropriation of ancestral lands
Native Americans– Genocide
Culture
Religion Spirituality Family Elders Tradition Process
Context
Racism Sexism Poverty Under-employment Lack of access No health insurance
Geography
Urban Rural Mountains Access to the sea Vieques
Community Competence
Primary
History Culture Context Geography
Relative and Dynamic: H/C/C/G African Americans and Latinos
– History and culture
Japanese and Chinese
– Apartheid South Africa (context)
Native American and Alaskan Indians
– Geography and culture
Secondary
Language
– Common usage
– Common knowledge
Literacy
– Reading level
– Design
Secondary
Salient Imagery Positive Imagery Multi-Generational Diversity
Community Competence
PrimaryConstructs1
+SecondaryConstructs2
1. History, Culture, Context, Geography2. Language, Literacy, Positive Imagery, Salient Imagery, Multi-generational, Diversity3. Person, Primary Family4. SES, Gender, Literacy5. Drug Treatment Centers, Physically Challenged, Prisons, Cancer Patients/Survivors6. AI/AN, AA/PI, Black, H/L, White, L/G/B/T, Religion
Individuals3 Strata4 Groups5 Communities6
Community Development
Community Development
Core Components
Capacity and Infrastructure
Social Capital
Community Development
Capacity and Infrastructure
– Research/Researchers
– Community Competent Programs(e.g., communications, training, service, education)
– Leaders
– Organizations
– Networks
Community Development (cont.)
Social Capital
– Cooperation
– Collaboration
– Reciprocity
– Trust
Community Development
Priority One
– Capacity and Infrastructure = car
Priority Two
– Social Capital = gas
Community Development
Capacityand
Infrastructure1
+Social Capital2
Individuals3 Strata4 Groups5 Communities6
1. Research, Researchers, Programs, Leaders, Organizations, Networks2. Cooperation, Collaboration, Reciprocity, Trust, 3. Person, Primary Family4. SES, Gender, Literacy5. Drug Treatment Centers, Physically Challenged, Prisons, Cancer Patients/Survivors6. AI/AN, AA/PI, Black, H/L, White, L/G/B/T, Religion
Community Prevention
Interventions Community Prevention– Community
Development– Community
Competence Prevention
– Policy– Education– Counter Marketing– Immunization
Control– Treatment– Pharmaceutical– Counseling
Intervention Components
CommunityPrevention1
Prevention2 Control3
1. Community Development, Community Competence2. Policy, Education, Counter Marketing, Immunization3. Treatment, Pharmaceutical, Counseling
Populations
Community– AI/AN, AA/PI, B, H/L, W, L/G/B/T, Religion
Groups– Drug treatment, physically challenged, cancer
patients/survivors Strata
– SES, Gender, Low Literacy Individuals
– Person, primary family
CONTROL1 PREVENTION2COMMUNITY
PREVENTION3
COMMUNITY COMPETENCE
COMMUNITYDEVELOPMENT
COMMUNITY COMPETENCE
COMMUNITYDEVELOPMENT
COMMUNITY COMPETENCE
COMMUNITYDEVELOPMENT
INDIVIDUAL4 X X X X XX XX
STRATA5 XX XX XX XX XXXX XXXX
GROUP6 XXX XXX XXX XXX XXXXXX
XXXXXX
COMMUNITY7 XXXX XXXX XXXX XXXX XXXXXXXX
XXXXXXXX
Model to Eliminate Population Disparities
1. Treatment, Pharmaceutical, Counseling2. Policy, Education, Counter Marketing, Immunization3, Control + Prevention4. Person, Primary Family5. SES, Gender, Literacy6. Drug Treatment Centers, Physically Challenged, Prisons, Cancer Patients/Survivors7. AI/AN, AA/PI, Black, H/L, White, L/G/B/T, Religion
Outcomes
PLAN
TO
ADDRESS
DISPARITIES
Activities Outputs
LOCATEAssess relevant data sources to identify tobacco-related disparities
LEARNIdentify gaps in
available data and assess
opportunities for expanded data
collection
Convene a diverse and inclusive group
of stakeholders
Long-termShort-term
Inputs
Health Department and Diverse
National, State, Tribal, Local and
Community Partners
Intermediate
DATA SYSTEMSA more sensitive data collection system is
created
COMMUNITY COMPETENT
INTERVENTIONSAppropriate and
effective interventions are developed
FUNDING & RESOURCES
Stable funding stream is identified
COMMUNITY DEVELOPMENT
Capacity / Infrastructure / social capital is developed
within specific populations
DIVERSITY & INCLUSIVITY
Partnerships and practice are
representative and equitable
Increased policy and
environmental change
Planningworkgroup
formed
DataSources
assessed
Capacity and infrastructure / social capital
assessed
Tobacco-related disparities identified
Qualitative and quantitative data needs identified
Dissemination and diffusion of
interventions
Institutionalization and leveraging of
resources
Community norms supportive of tobacco use
prevention and control efforts
Ongoing identification of tobacco-related
disparities
20
Ownership and substantive
participation in tobacco use
prevention and control
19
Reduced tobacco-related disparities
among specific populations
Increased social justice
1
2
3
4
5
6
7
8
9
12
1110
13
18
17
16
14
15
Identify and Eliminate Tobacco-Related Disparities
Prevalence (%) of Current Cigarette Smoking: Overall by Race—United States, 1965-2001
0
10
20
30
40
50
60
70
80
90
100
1965-1966
1970-1974
1978-1980
1983-1985
1987-1988
19901991-1992
1993-1995
1997-1999
2000-2001
Pe
rce
nt
WhitesBlacks
Source: National Health Interview Survey, United States, 1965-2001, aggregate data.
Current Cigarette Smoking
Guiding Principles
Heterogeneity/Diversity/Inclusivity Participatory Community and Race and SES Community Development Community Competence Service Policy Trust Comprehensiveness
Challenges
Measurement: qualitative and quantitative Resources Multi-sectorial: structure Analytic methods Breadth of indicators Unit of analysis
Robert G. Robinson, Dr.P.H.Associate Director for Health Equity
Office on Smoking and Health
TM
Community Development Model for Eliminating Disparities
